The following Stress Assessment is designed to help you quickly evaluate three important
aspects of your stress. The 154 questions cover:
1.Situations (Stressors) at Work and in your Personal Life that you perceive as stressful
2. Your Signs and Symptoms of Stress
3. The Effectiveness of your current Coping skills and Resources.

You can complete the Assessment and use the information to help guide you in your objective
to reduce the stress in your life. Then, you will be given the option to request Stress Less
to provide you with a custom designed program based on your scores and personal background
information.

1. STRESSORS
The following is a list of situations that many people find stressful. Please note those
situations that apply to you over the last six months or that you anticipate will apply
to you in the coming year. For each item that applies to you, press the button next to
the level of stress coping that you believe most accurately describes how effectively
you are coping with each stressor.

2. Strained
Frequent difficulty in coping, a sense
of overwhelm or feeling drained,
persistent feelings of anxiety, anger,
irritability, helplessness, worry,
gloom, some impairment in functioning
at work or personal life.

3. Balanced
Effective and relatively stable
functioning at work and/or personal
life. Occasional distressing feelings
which are appropriate and minimally
disturbing or disruptive.

The following is a list of Physical, Mental, Emotional and Behavioral symptoms of Stress. If a symptom applies to you over the past 6 months or you anticipate the symptom occuring in the coming year, please rate the severity of the symptom you have experienced or anticipate experiencing on the 4 point scale next to the item.

1= Severe; 2 = Moderate; 3 = Mild; 4 = Low

Physical Symptoms:

1= Severe; 2 = Moderate; 3 = Mild; 4 = Low or None

Chest Pain

1 2 3 4

Headaches(Tension Migraine)

1 2 3 4

Back pain

1 2 3 4

Tense Neck and Jaw

1 2 3 4

Throat Constriction, difficulty swallowing

1 2 3 4

Muscle Cramps

1 2 3 4

Sleeplessness

1 2 3 4

Sexual Difficulties, Loss of Sexual Interest

1 2 3 4

Dizziness

1 2 3 4

Cold Hands/feet

1 2 3 4

Fatigue, Low Energy, tired

1 2 3 4

Bloating

1 2 3 4

Diarrhea

1 2 3 4

Nail Biting

1 2 3 4

Reduced Immunity(Frequent Colds/Flu, Allergies or Infections)

1 2 3 4

Heart Racing/rapid pulse

1 2 3 4

High Blood Pressure

1 2 3 4

Shortness of Breath

1 2 3 4

Over Eating

1 2 3 4

Loss of Appetite

1 2 3 4

Ulcers

1 2 3 4

Colon problems

1 2 3 4

Voice Shaky, Stuttering or Strained

1 2 3 4

Tight muscles or Muscle aches

1 2 3 4

Bruxism (grinding or teeth clenching)

1 2 3 4

Frowning, wrinkled forehead

1 2 3 4

Trembling or shaking

1 2 3 4

Gas pains or cramping

1 2 3 4

Acid Stomach, Heartburn

1 2 3 4

Constipation

1 2 3 4

Nausea

1 2 3 4

Mental Symptoms

1= Severe; 2 = Moderate; 3 = Mild; 4 = Low

Forgetfulness

1 2 3 4

Negating own ideas

1 2 3 4

Disorganized thinking

1 2 3 4

Mental chatter

1 2 3 4

Mind racing

1 2 3 4

Lack concentration/attention

1 2 3 4

Obsessive thinking

1 2 3 4

Worry

1 2 3 4

Unable to prioritize

1 2 3 4

Decision making difficulties

1 2 3 4

Automatic thoughts/images

1 2 3 4

Irrational beliefs and self talk

1 2 3 4

Emotional Symptoms

1= Severe; 2 = Moderate; 3 = Mild; 4 = Low or None

Anger, Irritability

1 2 3 4

Anxiety, Panic, Fearful

1 2 3 4

Depressed, Sad, Downhearted, Blue

1 2 3 4

Feel strong dependency need

1 2 3 4

Helpless

1 2 3 4

Hopeless

1 2 3 4

Lonely

1 2 3 4

Pessimism

1 2 3 4

Unworthy

1 2 3 4

Flattened Affect

1 2 3 4

Blaming

1 2 3 4

Guilt

1 2 3 4

Impatient

1 2 3 4

Frustrated

1 2 3 4

Feel inadequate

1 2 3 4

Personal Behavioral SIGNS

1= Severe; 2 = Moderate; 3 = Mild; 4 = Low

Lack close relationships

1 2 3 4

Low trust

1 2 3 4

Non assertive

1 2 3 4

Won't take risks

1 2 3 4

Avoid challenges

1 2 3 4

Dull & Boring

1 2 3 4

Avoid change

1 2 3 4

Poor love relationships

1 2 3 4

Limit social life, Withdraw

1 2 3 4

Lack control over life

1 2 3 4

Poor self-esteem

1 2 3 4

Fear commitments

1 2 3 4

Lack self forgiveness

1 2 3 4

Indecisive

1 2 3 4

Make unrealistic demands

1 2 3 4

Coercive

1 2 3 4

Lack Drive, Unmotivated

1 2 3 4

Over reacting

1 2 3 4

Passive, Dependent, Controlled by others

1 2 3 4

Poor family harmony

1 2 3 4

Domineering

1 2 3 4

Unable to reach out to others

1 2 3 4

Critical

1 2 3 4

Marital problems

1 2 3 4

Alienation

1 2 3 4

Poor communications

1 2 3 4

Molehills into mountains

1 2 3 4

Lack compassion

1 2 3 4

Jealousy

1 2 3 4

Can't relax

1 2 3 4

Unable to express true feelings

1 2 3 4

Work Behavior SIGNS

1= Severe; 2 = Moderate; 3 = Mild; 4 = Low

Over eating

1 2 3 4

Lack response to Challenge

1 2 3 4

Choices related to self imagerather than reality

1 2 3 4

Lose creativity

1 2 3 4

Oppositional/Hostile

1 2 3 4

Rigidity/By the book

1 2 3 4

Poor Performance

1 2 3 4

Low motivation

1 2 3 4

Lack self initiative

1 2 3 4

Absenteeism

1 2 3 4

Low aspirations

1 2 3 4

Accept low status

1 2 3 4

Trying to over please others

1 2 3 4

Avoid responsibility

1 2 3 4

Avoid risks

1 2 3 4

Inability to work well with others

1 2 3 4

Poor time management

1 2 3 4

Too Controlling

1 2 3 4

Create tension in others

1 2 3 4

Poor communications

1 2 3 4

Waste time/Procrastination

1 2 3 4

Poor skill development

1 2 3 4

Unable to complete tasks

1 2 3 4

Crisis oriented

1 2 3 4

Lack respect for others

1 2 3 4

Low delegation

1 2 3 4

Lack interpersonal skills

1 2 3 4

Overwork

1 2 3 4

Lose clarity of goals

1 2 3 4

Competitive

1 2 3 4

3. STRESS COPING SKILLS AND PERSONAL RESOURCES

The following is a list Coping Skills, Habits and Personal Resources that are effective for combating and preventing Stress.

Please rate on the four point scale the level of your ability to apply each skill to reduce your stress: Rating Scale: 1= Very poor 2 = low or moderate 3 = good 4 = Very good.

1.Diet and Nutrition

I have good nutritional habits that include eating a balanced diet, taking appropriate nutritional supplements and limiting caffeine, sugar and fat intake.

1 2 3 4

2. Relaxation

I am aware when stress builds up in my body and use relaxation techniques to reduce body tension.

1 2 3 4

3. Physical Exercise

I am physically fit and use regular exercise to combat and prevent stress.

1 2 3 4

4. Social Support

I am able to ask for and receive support from friends, family members or professionals as a buffer against stress.

1 2 3 4

5. Communication

I am able to effectively listen to others and comfortably express my own thoughts, feelings and opinions.

1 2 3 4

6. Assertiveness

In conflict situations, I am able to speak up on my own behalf, honestly express my opinions, feelings, and wishes, give constructive criticism, and refuse unrealistic requests.

1 2 3 4

7. Financial

I am good at managing money, do not needlessly worry about financial matters, and have enough money to meet most of my needs and use in the service of reducing stress.

1 2 3 4

8. Time Management

I am able to efficiently manage my time.

1 2 3 4

9. Taking Action

I am able to establish priorities, take action on my plans, goals and set limits, schedule effectively, avoid procrastination and pace my efforts.

I am able to change rigid and absolute stress inducing beliefs into more functional beliefs such as "I can be happy even if others disapprove of me", "the world doesn't have to meet my wishes all the time", and "I don't have to be perfect to be worthwhile."

1 2 3 4

13.Humor

I do not take myself too seriously and use humor to balance life's frustrations

1 2 3 4

14. Spiritual

I believe in a higher power and spiritual connectiveness to life.

1 2 3 4

Please press the Submit button when you have completed the questionnaire. Your results will be processed immediately.